The state of California has made it clear it won't play a role, Gioia told me late Monday, and Kaiser Permanente and John Muir Health "so far are not willing to be part of any long-term, continued funding of the hospital," which provides ER and other services to about 250,000 residents of West Contra Costa County.

Both Oakland-based Kaiser and Walnut Creek's John Muir have provided millions in earlier subsidies to keep the San Pablo hospital from closing.

If the hospital does close this summer, as seems increasingly likely, Gioia said the county and others may step in to augment other forms of care in the area. The county has two clinics in West County, in San Pablo and North Richmond.

Other options being discussed are a stand-alone ER or urgent care center, although Gioia cautioned that there currently is no licensed stand-alone emergency room in the state, and such a center would need agreements with other local hospitals to admit patients who needed post-ER hospitalization.

"Any last-minute effort would take a multi-party solution," Gioia said. "The county doesn't have the financial ability to maintain the hospital on its own."

The Contra Costa supervisors are under fire from several unions, including the California Nurses Association and the National Union of Healthcare Workers, both of which represent significant numbers of workers at Doctors, to take on management of the hospital, but that seems highly unlikely.

The West Contra Costa Healthcare District Board is expected to vote late this month to proceed with closure of the facility by mid-summer, barring a last-minute bailout.

NUHW, which represents 300 workers at the hospital, and CNA, which represents about 300 RNs there, want the county to take control. A protest is scheduled for Tuesday morning in Martinez at the supervisors' meeting.

“Alameda County acted to save its acute care facilities which included San Leandro and Alameda Hospitals,” said Seung Choo, an RN who works in Doctors' medical intensive care unit. “West County needs more hospitals, not less, especially when nearby refineries can harm thousands," referring to possible accidents at the nearby Chevron complex in Richmond.

Choo, an El Cerrito resident, said the supervisors "must act to prevent a potential healthcare catastrophe.”

The closest emergency room to San Pablo is Kaiser's small Richmond facility, which can't accommodate the same level of use. The county's Contra Costa Regional Medical Center in Martinez and Alta Bates Summit Medical Center in Berkeley and Oakland are the other closest hospitals.

"It depends what your priorities are," R.N. and CNA public sector leader Sue Fendley said when informed of Gioia's comments.

But neither CNA nor NUHW gave any examples of county supervisors who are in favor of a Contra Costa County takeover of the troubled hospital.